重型颅脑损伤术后早期并发癫痫持续状态的危险因素分析

Analysis of risk factors for early postoperative status epilepticus after severe traumatic brain injury

目的 探讨重型颅脑损伤(sTBI)患者术后早期并发癫痫持续状态的相关危险因素。方法 回顾性分析厦门大学附属中山医院神经外科2016年1月—2021年12月收治的78例sTBI手术患者的临床资料,术后出现早期癫痫持续状态的患者18例作为病例组,其余60例作为对照组,运用Logistic回归探索sTBI术后早期并发癫痫持续状态的危险因素。结果 病例组的机械通气、脑疝发生、术前GCS评分3~5分及术中低血压发生比例显著高于对照组,经二元Logistic多因素回归分析发现,其中机械通气是sTBI术后早期癫痫持续状态发生的独立危险因素。术前GCS评分高的sTBI患者术后早期癫痫持续状态发生的可能性比GCS评分低的患者小。结论 sTBI术后早期癫痫持续状态是颅脑损伤救治中的难题,该类患者应尽早行减压手术解除脑疝,术后保持呼吸道通畅,注意机械通气,尽可能减少脑组织发生缺氧缺血性损伤,并给予适当镇静,可减少术后早期癫痫持续状态的发生率。

Objective To explore the risk factors of early postoperative status epilepticus in patients with severe traumatic brain injury(sTBI).Methods The clinical data of 78 patients with sTBI admitted to Department of Neurosurgery,Zhongshan Hospital Affiliated to Xiamen University from January 2016 to December 2021 were analyzed retrospectively.18 patients with early epileptic status after sTBI were treated as the case group,and the remaining 60 patients as the control group.Logistic regression was used to explore the risk factors for early epileptic status after sTBI.Results The incidence of mechanical ventilation,cerebral hernia,preoperative GCS scores of 3-5,and the incidence of intraoperative hypotension in the case group were significantly higher than those in the control group.Through binary logistic regression analysis,it was found that mechanical ventilation was an independent risk factor for the occurrence of early status epilepticus after sTBI.High preoperative GCS score was a protective factor for the occurrence of early status epilepticus after sTBI.Conclusions Early epileptic status after sTBI is a difficult problem in the treatment of brain injury.Such patients should undergo decompression surgery as soon as possible to relieve cerebral hernia,maintain airway patency after surgery,pay attention to mechanical ventilation,minimize hypoxic ischemic injury to brain tissue,and provide appropriate sedation to reduce the incidence of early epileptic status after surgery.